Make a referral


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Kites accepts referrals from parents, carers, family members, allied health professionals, GPs and other specialists.

To get started with your referral to Kites therapy, please fill in our easy online referral form below. If you have information about your child or patient’s diagnosis or medical history, keep it handy to supply with your application.

Don’t like filling in forms? No worries! Contact us or call us on (03) 6245 9232 and we’ll take care of everything you need to get you started on your Kites journey today.

Therapy for Children & Youth Referral Form

Details of child

Australian Residency Status *

Details of parents(s) / guardian(s)

Parent/guardian 1 address *
Parent/guardian 2 address

Details of referral

Please attach copies of diagnostic reports (if available)

Maximum file size: 10MB

Attach up to three PDF or Word documents. Maximum upload size is 10 Mb.
Type of therapy requested
Does your child engage in any behaviours that may compromise the safety of our therapy dog?

Contact details of Referrer

Complete this section only if the referrer is not the parent
Declaration *